Provider Demographics
NPI:1356672653
Name:WILLIAMS, KAREN STELLA (COTA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:STELLA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:97450 N. 19TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7967
Mailing Address - Country:US
Mailing Address - Phone:602-324-6500
Mailing Address - Fax:602-324-6520
Practice Address - Street 1:1 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-0217
Practice Address - Country:US
Practice Address - Phone:541-469-3111
Practice Address - Fax:541-469-5970
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1031820224Z00000X
CAOTA426224Z00000X
WAOC60067631224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant